An exploratory study examining service users views and experiences of Contingency Management

1. An exploratory study examining service users views and experiences of Contingency Management Vikki Charles, Tim Weaver, Nicola Metrebian, Nicholas Little, Steve Pilling and John Strang

2. Background • Strong evidence base for CM in the USA (Petry et al, 2001) • NICE guidance (2007) • 14 CM NTA pilot sites (2008) – Hep B/abstinence – opiates and crack/attendance • No published data on the experience of CM in drug settings from a SU perspective • NIHR ConMan Programme Grant (2009)

3. Aims • to explore and describe the treatment experiences of SU who had participated in CM • to assess the acceptability of CM from a SU perspective

4. Method • Qualitative focus groups (2010) • 8 (Hep b and abstinence) groups in 6 NTA pilot sites • 2-6 participants in each group • Purposive sample • Thematic analysis – Nvivo 8 • Subtle realist interpretation

5. Findings – Views of CM “I know it’s a bit annoying for people who don’t take drugs thinking why should they [drug users] get something, because I can see both sides but its just it’s the only way that works. I think it gives an incentive and it is a bit unfair on people who don’t take drugs but if it is going to cure the biggest thing, I think it’s a good idea.” (Hep B)

6. Conflicting views • Felt like a bribe • Showed that the service cared • The best thing about being involved was spending the vouchers

7. Who CM would work for? “.. in all fairness if somebody’s bang into it and using gear full stop, then contingency management would do jack for it. You’ve got to want to come off it. I know the methadone helps and the subutex helps but you’ve really got to want to come off it. It’s a mental thing.” (abstinence - opiates)

8. Motivating factors • Vouchers worked as a hook • Health benefits and self challenge • Motivations shifted from vouchers to wanting to achieve target and prove to self and others including staff – pride

9. Motivating factors (2) “So I wanted to stop and I was moving into a flat and when they said they were going to give me some vouchers I thought to myself ‘okay, I’ll save the vouchers and buy my own dinner set’. And I did. ….I saved it, the vouchers and bought a dinner set when I moved into my flat. Do you understand what I’m saying? It kept me clean because of the incentive.” (abstinence - crack)

10. Impact on self “For them to say to you well done, it makes you feel good inside, it gives you the incentive to want to carry on and do it, it makes you noticed as a person, not just as a junkie because junkies are not noticed are they?” (abstinence - opiates)

11. Monetary reinforcer • Immediate gratification? • Supervised spending • Voucher v cash • Voucher economy

12. Therapeutic relationship • No deleterious impact • Relationship with staff important • Attitude and demeanour important • Increased support beneficial – for most

13. Concluding comments • Overall CM had a high level of acceptability • No sense of a loss of autonomy • Increased sense of self worth • Research continuing